Cardiac surgeon ARVIND KOSHAL
insures the future, one bypass at a time

“One of the most outstanding things in my memory is the first artificial heart transplant in Canada,”
recalls cardiovascular surgeon Dr Arvind Koshal of the time,
a quarter century ago, when he trained at the Ottawa Heart
Institute with Dr Wilbert Keon.

“We had just received our training for the Jarvis hearttransplant. A young woman was in the operating room. Inany other circumstances, she would have been declared dead,because she had a massive heart attack. I was part of theteam of cardiovascular surgeons who translated that history-making Jarvis artificial heart and saved her life.”It was, he recalls, a time of considerable anxiety. They hadto wait seven days before replacing the human heart with anartificial one. But such patience was rewarded when the sur-gery progressed smoothly.

“The patient survived, and lived for some 18, 20 years,” says
Koshal, listing it as one of those experiences no one who was
part of it can ever forget. The first ever artificial heart transplant in Canada naturally generated considerable media
buzz, and “That made a huge impact on us on the use of an
artificial device, particularly their useful role as a bridge to
transplantation,” says Koshal.

That experience proved seminal. Thus, when he becameDirector of the Division of Cardiovascular and ThoracicSurgery at the University of Alberta in Edmonton, and sur-geon-in-chief, cardiovascular surgery at the University ofAlberta Hospital in 1991, he envisioned and promoted thedevelopment of “an outstanding cardiac institute inEdmonton.”Thanks to his belief and drive, Alberta now has the HeartInstitute, a 600,000 sq. ft building that has 132 beds, all forcardiac patients, which Prime Minister Stephen Harper hadinaugurated and which opened its doors to patients in July thisyear.

The Institute became possible when in 2001 the Government
of Alberta recognized the Cardiac Sciences Program in
Edmonton to be a Center of Excellence, for which an initial
sum of $125 million was allocated. Interestingly, the community raised $37 million for the project and buoyed by this, the
Alberta government added an extra $22 million to complete
the project.

“This is paying for the future,” he says about the Institute. “Itbrings me a tremendous sense of fulfillment; I feel so humbledwhen I look at this building.” That sense of achievement wasfurther heightened when his former boss and mentor Dr Keonvisited him in Edmonton, and told him ‘”There won’t beanother heart institute in Canada like this one.’For all his developmental work, Koshal is at heart a surgeon,who estimates that during his 32 years in practice he has per-formed at least 8,000 bypass surgeries. He uses the conven-tional method, where the heart is stopped after the patient ishooked to the heart-lung machine – a method he believes is

safer than the more modern beating heart surgery.

Safe does not however mean fool-proof, says Koshal, admit-ting that he has lost the odd patient during his career. “Ourmortality rate is 1 to 2 percent, which is acceptable. Some peo-ple are in very desperate straits – no matter what you do, youcannot save them. But by and large, it is very unusual now tolose a patient on the table. We have so many things that we cando now, but medical science is still not perfect.”He has published extensively, and been widely honored. In1994, he received the Wilbert J Keon Award for outstandingcontributions in the field of cardiovascular medicine, and in1999 he was elected president of the Canadian Society ofCardiac Surgeons.

He recalls how he was attending a wedding in Goa lastNovember, when the call came in to inform him that he hadbeen named for the Order of Canada award for 2008. The cita-tion that came with the award said he was being named for his‘contributions to the field of cardiac surgery in Canada, notablyin performing several innovative techniques, and for his lead-ership in developing one of the leading cardiac care programsin the country.’“With all these recognitions and a sense of fulfillment that theAlberta Heart Institute has finally opened its doors, it is nice tokeep my head down and keep working,” Koshal says. “There’slot of work yet to be done. I have to make sure that the HeartInstitute really runs well, and it really becomes world class cen-ter that I wanted it to be.”